左心膜破裂を伴った外傷性大動脈解離の１例

Abstract

We report the case of a 64-year-old housewife with a diagnosis of acute traumatic aortic dissection associated with left pericardial rupture. The patient suffered multiple left rib fractures, a right wrist fracture, fracture of the right ankle and open fracture of the left ankle. She was transferred to our hospital complaining of severe back pain and increasing blueness of the right leg, which suggested cyanosis due to advancing dissection of the aorta. Enhanced CT and intra-arterial DSA confirmed dissection of the descending aorta from the distal portion of the left subclavian artery to the right iliac artery. Standard left thoracotomy revealed pulsatile patent ductus arteriosus (PDA) and traumatic rupture of the left pericardium. The PDA was divided first. Because of the multiple injuries, a heparin-coated cardiopulmonary bypass system was used to reduce the dose of heparin. Dissection was noted around the proximal descending aorta, with the point of entry observed above and below the PDA. This finding supports the observation that traumatic rupture of the thoracic aorta occurs most frequently in the area of the ligamentum arteriosum, because the aorta is fixed at that point. The descending aorta was successfully replaced with an artificial vascular graft. Three traumatic dissections have been reported, including our case, in Japan. In our patient surgery was performed 10 hours after the injury. This may represent the earliest operative treatment of traumatic aortic dissection in Japan thus far.